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MA13 - Denial Journal
RARC

MA13

Alert: possible penalties for billing the patient amounts not reported with the PR group code

What This Code Means

An informational alert reminding the provider that only amounts reported under the PR (Patient Responsibility) group code may be billed to the patient.

Common Causes

  • Provider billing patient for a CO (contractual) or OA adjustment in error

How to Resolve or Appeal

  1. Review which adjustments are marked PR vs. CO/OA on the remittance
  2. Only bill the patient for amounts under the PR group code

More Denial Codes to Check

CARC CO-96 Non-covered charge(s) RARC M90 CARC CO-303 CARC CO-51 CARC CO-45 Charge exceeds fee schedule/maximum allowable or contracted amount CARC CO-160 RARC M80 CARC CO-147 Provider contracted/negotiated rate expired or not on file RARC M37 CARC CO-269 RARC M82

Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.

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